The IPERGAY study (2015) It established the evidence that a pill taken before having unprotected sex prevented the acquisition of HIV (pre-exposure prophylaxis or PrEP). And the PREVENTION, in progress, is the biggest event in real life, and is on track to confirm that efficiency of about 97%. Both have a common principal investigator, Jean-Michel Molina, a Frenchman born in Algeria 60 years ago with Spanish ancestry. This Parisian doctor is more than a scientist. Acts as a standard bearer that "you have to include PrEP in plans to eradicate AIDS, with him early diagnostic and the early treatment (and without forgetting the condom). "The problem is that" governments are too shy to implement it. "
Molina has been on February 8 in Madrid to attend the HIBIC, a meeting on HIV research sponsored by Gilead, the laboratory that makes the pill. You almost do not have to ask. He only lists the findings, the "skeptical" complaints, and his response to the statements of those who from scientific, economic and ethical points of view question what he advocates: "That access to PrEP is a human rights issue Everyone has the right to live a free sexuality without the anguish of thinking that they can become infected with HIV, because let's be honest, although the situation has improved a lot, the diagnosis is not good news. to their family and their environment, and they have to go to the doctor for consultations and tests, and that in rich countries. people still die of AIDS. "
In the PREVENTION study, all participants (more than 2,100 currently, with plans to reach 3,000) have access to the pill that prevents AIDS. Men who have sex with men have been chosen "because among them the incidence of HIV is high, and there must be many cases to do the study," Molina explains. Once established in the IPERGAY that the effectiveness as protection is 97% – "at the level of the condom," says the researcher -, the two groups of work have been shaped according to the regime in which they will take the medication: those that They do it every day, or those who only do it before a relationship. "Preliminary data indicates superior protection, there has not been a transmission." In France, the pill for PrEP is free for users "so as not to create inequality in access". And the recommended pattern is, if you want to use sporadically, take two between 24 and 2 hours before the relationship, and then one at 24 hours and another at 48. "But people do not always follow this pattern or the of daily use, they change according to their interests ".
With this evidence, the doctor responds without hesitation to the problems that the implementation of the method receives. "Some people say that why give a pill for something that could be solved with a condom, but that is as if we told women that we do not give them birth control pills because they can use condoms, everyone has to be able to enjoy their sexuality. There will be whoever wants the pill, who uses the condom and who wants to make sure using both methods, but that is their right, "he insists.
It also argues that its use should be restricted because Sexually transmitted diseases (STDs) increase. Apart from the simile with the contraceptive pill, he points out that "STDs were already increasing before PrEP, and, being honest, they are cured quite easily and can not be put on the same level as HIV," he says. And, in addition, he adds that people who receive PrEP will receive a continuous medical follow-up, since they will have to go to the doctor for the prescription, which will allow them to detect beforehand if they have HIV or another disease, to vaccinate them from the STDs that have a vaccine and address other aspects, such as drug use that is associated with some risk behaviors (the call chemsex, generally group relationships stimulated with drugs in sessions that last for hours).
Finally, it denies the economicist argument. "In France, a person with HIV will cost the system around 500,000 euros throughout his life.The box of 30 pills costs 200 euros at the pharmacy, and it is estimated that each year they have to receive PrEP between 60 and 70 people. avoid a transmission, spending compensates. " Doing some numbers, that means that in the worst case, the medication of those 70 people with a daily pill is 168,000 euros. And that is assuming that everyone takes it daily, because if they follow a regime on demand (only when they foresee that they will have sex) it will be less. And that without counting that there are already generic medications, which cost a quarter. "People will not be taking the pill all their lives, they will do it when they do not have a monogamous partner, when they are sexually active," she explains. To avoid suspicion, the French Government also reimburses condoms, so the two methods are free.
Molina is convinced that everyone who feels they need it should be able to access the pill. "It is not an emergency method for promiscuous gays, it should not be associated with them, because then there will be those who do not want to receive it or who think it is not for it." Only people in a monogamous couple with a person without HIV or with HIV but treated and with undetectable viral load [que la concentración de virus en su sangre es tan baja que no se puede transmitir] they are not candidates to receive it, "he insists." What is unacceptable is that we give a diagnosis of HIV to someone who we have not informed before there was a way to avoid it, "he concludes.
The head of the National Plan on AIDS, Julia del Amo, announced last November that the Ministry of Health was studying how to implement the use of PrEP (pre-exposure prophylaxis, the pill that prevents contracting HIV). On February 5, the head of the department, María Luisa Carcedo, convened a plenary session of the National Commission for Coordination and Monitoring of AIDS Prevention Programs, which did not meet in four years. And in it he advanced how the situation was.
As reported by people who attended the meeting, they were informed that in November 2019 it was agreed with the laboratory that produces the pill, Gilead, an agreement to donate it to study the viability of the plan to extend it.
The General Directorate of Public Health, on which the Plan depends, has already requested the corresponding permit from the Public Health Commission, which must answer in March. Now it is necessary for the communities to give the number of candidates to receive this treatment, to set up a working group for the implementation.
Spanish NGOs and scientific societies clearly support the extension of the use of this measure, and Sanidad agrees with the general idea, but it is necessary to set the access conditions and calculate their impact.